Provider Demographics
NPI:1871315754
Name:CONCIERGE NUTRITION INC
Entity type:Organization
Organization Name:CONCIERGE NUTRITION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BAHAR
Authorized Official - Middle Name:MONA
Authorized Official - Last Name:SOLASI
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:310-880-9633
Mailing Address - Street 1:17208 LUVERNE PL
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-3932
Mailing Address - Country:US
Mailing Address - Phone:310-880-9633
Mailing Address - Fax:818-975-2178
Practice Address - Street 1:17208 LUVERNE PL
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-3932
Practice Address - Country:US
Practice Address - Phone:310-880-9633
Practice Address - Fax:818-975-2178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty